EBM 2024: Lecture 1

Definition and Importance of Evidence-Based Medicine

Austin Meyer, MD, PhD, MS, MPH, MS

2024-08-30

Definition and Importance of Evidence-Based Medicine (EBM)

What is Evidence-Based Medicine?

  • Integration of:
    • Best research evidence
    • Clinical expertise
    • Patient values and preferences

Importance of EBM in Clinical Practice

  • Improves patient outcomes
  • Enhances quality of care
  • Promotes efficient use of resources
  • Keeps practitioners updated with latest research

The EBM Process

  1. Ask - Formulate clinical question
  2. Acquire - Gather relevant evidence
  3. Appraise - Evaluate evidence quality
  4. Apply - Integrate with patient care
  5. Assess - Evaluate outcomes

The EBM Process: Ask

Formulate a clear clinical question - PICO

The EBM Process: Acquire

  • Search for the best available evidence
  • Utilize databases like PubMed, Cochrane Library
  • Cochrane

The EBM Process: Appraise

The EBM Process: Apply

  • Integrate evidence with clinical expertise
  • Consider patient preferences and circumstances

The EBM Process: Assess

  • Evaluate the outcome of the decision
  • Reflect on the process and identify areas for improvement

Levels of Evidence

Question 1

A 7-year-old boy with a history of recurrent asthma exacerbations presents to the clinic. His parents are concerned about the long-term effects of inhaled corticosteroids and have read conflicting information online. They ask whether continuing the medication is the best option for their child. As a clinician using Evidence-Based Medicine (EBM), what is the first step you should take to address their concerns?

Question 2

A pediatric resident is reviewing a recent study that suggests a new treatment for pediatric eczema. The study is a randomized controlled trial (RCT) with a large sample size and demonstrates statistically significant results. According to the principles of Evidence-Based Medicine (EBM), which of the following best describes the importance of this study’s findings?

Question 3

Which of the following best exemplifies the integration of patient values and preferences in the practice of Evidence-Based Medicine (EBM) for a pediatric patient?

Research Methods Overview

Types of Clinical Research

Experimental vs. Observational Studies

  • Experimental Studies
    • Interventions are actively manipulated.
    • Example: Randomized Controlled Trials (RCTs).
  • Observational Studies
    • No intervention; researchers observe outcomes.
    • Example: Cohort studies, Case-control studies.

Study Designs

  • Randomized Controlled Trials (RCTs)
    • Gold standard for assessing causality.
    • Random assignment to intervention or control.
  • Cohort Studies
    • Observational; follows a group over time.
    • Can be prospective or retrospective.
  • Case-Control Studies
    • Compares individuals with a condition (cases) to those without (controls).
    • Efficient for studying rare diseases.
  • Cross-Sectional Studies
    • Snapshot at a single point in time.
    • Useful for prevalence studies.

Randomized Controlled Trials (RCTs)

Gold Standard for Causality

Cohort Studies

Observational Study Design

Case-Control Studies

Retrospective Study Design

Cross-Sectional Studies

Snapshot in Time